Janelle L Kyllo Bouchie, PA-C in Detroit Lakes, MN - Medicare Physician Assistant Provider

Janelle L Kyllo Bouchie, PA-C is a medicare enrolled "Physician Assistant" provider in Detroit Lakes, Minnesota. Her current practice location is 1027 Washington Ave, Detroit Lakes, Minnesota. You can reach out to her office (for appointments etc.) via phone at (218) 847-5611.

Janelle L Kyllo Bouchie is licensed to practice in Minnesota (license number 12809) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1366716102.

Contact Information

	Janelle L Kyllo Bouchie, PA-C
	1027 Washington Ave, Detroit Lakes, MN 56501-3409
	(218) 847-5611
	Not Available

Healthcare Provider's Profile

Full Name	Janelle L Kyllo Bouchie
Gender	Female
Speciality	Physician Assistant
Location	1027 Washington Ave, Detroit Lakes, Minnesota
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1366716102
Provider Enumeration Date: 02/24/2012
Last Update Date: 11/10/2021

Medicare PECOS Information:

PECOS PAC ID: 0143573311
Enrollment ID: I20181106000177

Medical Identifiers

Medical identifiers for Janelle L Kyllo Bouchie such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1366716102	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
225XP0200X	Occupational Therapist - Pediatrics	OT-1120 (Idaho)	Secondary
363A00000X	Physician Assistant	12809 (Minnesota)	Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Janelle L Kyllo Bouchie is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Janelle L Kyllo Bouchie, PA-C 1702 University Dr S, Fargo, ND 58103-4940 Ph: () -	Janelle L Kyllo Bouchie, PA-C 1027 Washington Ave, Detroit Lakes, MN 56501-3409 Ph: (218) 847-5611

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Janelle L Kyllo Bouchie, PA-C - Medicare in Detroit Lakes, MN